DS-18-37284
Miami Shores Village RECEIVED
Building Department DEC 2 01018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
C FBC 20 1---4
BUILDING CA F�UrnU Master Permit No.DE�� 19) " S--1 -z8
PERMIT APPLICATION Sub Permit No.
[71BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1015 1 N E 14 AVL' ill Ja
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):O e 1 14 3-_507 Phone#:
Address: a-450 0•11 - —r1 two-,.
City: State: L Zip:--:Ot'22
Tenant/Lessee Name: d 1/I A Phone#:
Email:
CONTRACTOR: Company Name
Address:
City:
Qualifier Name:
State Certification or Registration #
rtificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Peimit: $,��"— 1320 Square/Linear Footage of Work:
Type of Work: ❑ Addition ,«Ti,Alteratiorr ❑ New [ERepair/Replace ❑ Demo ition
Description of Work:. ( oe.v�)
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
CCF $ `' '"' "'CO/CC $"
DBPR $
Notary $.
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ 12 ` /� " 1 2— vy 9
TOTAL FEE NOW DUE $ 1 S2. • 1y
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.% A A 1
Signature " -�J�
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of L l tP 1A6.&i ) 20 1�J by
�I+rX JC So ob,11 , who is ersonally know o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
r
Sign:_
Print:
Seal: HELEN ME11A
Notary Public State of Florida
( omission r GG 182906
My ( om. Expires Mar 27, 2012
N+awiM through National Notary Assn.
APPROVED BY
as
R
The foreocling instr ent was acknowledged beforprne this
day of 'PAi20 by
who is personally known to
me or who has produced -<�" as
identification
NOTARY PUBLI *'N*bry Abbe State of Florb
Jorge Reasons
INr Coaaiahriw GG 1"011
EsPIM OSI04m
Print:
Seal:
Plans Examiner G "Z�f Zoning
Structural Review
Clerk
m
(Revised02/24/2014)
RECEIVED
Miami Shores Village QL'ADC 2 0 0
Public Works Department �...�/'
(305)795-2210
Public works forms are available from the building department, 10050 NE 211 Ave., Miami Shores, FL 33138
'r
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right-ofa orb -Miami ores Village or Miami -Dade Property
I JJJ
Permit#: J
Name of Applicant (if utility see below): *1iC21 �f 0,tyL r 33 Off- L(J�.•
Owner off the following described property: lylktm6hcr[f5 Ba Pori;
Legal Description: Lot Z Block 3 Subdivision ES-Faie_n
Folio #;
Address: 10 i 5 I WE 14 AVeni C�
UTILITY NAME: ,.
Qualifier/Authorized Agent:
Address:
City:
Telephone: Email:
State Certification or Registration #:
CONTRACTOR NAM
Qualifier/Autborize
Addressi VIC
City:
State:
ZIP:
Certificate of Competency #
_ State: 10411 ZIP: !�F7
Telepho : 'i Email: a—�
State Ce ion Re i tra ion Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: ) Ad
CoYvWO tFC0(_'W 6Uf.
Type of Work: LI Paving ❑ Utility ❑
❑ :Landscape,, Antenna ❑ Other:
DESIGNER: A`rcfiite&/t1itine'er'}1< < 7�:-i•
Address:
City:
Telephone: _
Registration #: _
Value of Work for this Permit
State:
Email:
k ❑ Electric ❑ Irrigation
ZIP:
$��_ Square/Lineal Footage of Work:
210
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ k I 1 - �d
Bonding Company's Name (if applicable):
Bonding Company's Address:
City:
State:
P:
Application is hereby made to obtain a public works permit to do the work in the right of way and
installations as indicated. I certify that no work or installation has commenced prior to the issuance of a
permit and that all work will be performed to meet the standards of all laws, regulation construction in
this jurisdiction. I understand that separate permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
right-of-way.
"WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a public works permit with an estimated value
exceeding $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved ana reinspection will be charged.
Signature '
Applicant or Authorized Agent
The forego* g instrument was acknowledgedbefore
me this �7 day of U& /A Q� 20 by
who
i ersonally known to me o ho has produced
as
identification.
Sign:
Print: X.(;iL! p�'t Sri►(
SEAL:
'HELENMEIIA
Notary Public Stale' of Florida
, � y ( on+mission N GG 182906
My ( amm. Expires Mar 27, 2022
Ornxled 1hrnt1gh National Notary Assn.
Signature \.dm
Com ny �lity Agent
The foreAd'ayof
nstru was acknowledge fore 3
me this 0 T by
who
is personally known to me or who has produced
as
identification.
i 1i ot,; ' iie ate of Florida
Sign:
Print:
SEAL:
APPROVED B Public Works Director, or Designee
2017-04-15